Provider Demographics
NPI:1548490063
Name:ORTHOPAEDICS SPINE AND SPORTS MEDICINE LLC
Entity type:Organization
Organization Name:ORTHOPAEDICS SPINE AND SPORTS MEDICINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TASSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-795-3033
Mailing Address - Street 1:115 EILEEN WAY
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-5323
Mailing Address - Country:US
Mailing Address - Phone:516-795-3033
Mailing Address - Fax:516-795-3036
Practice Address - Street 1:115 EILEEN WAY
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-5323
Practice Address - Country:US
Practice Address - Phone:516-795-0333
Practice Address - Fax:516-795-3036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6296370001Medicare NSC